Case Report
A 53-year-old Spanish speaking female with a past medical history of Rheumatoid Arthritis/Systemic Lupus Erythematosus (RA/SLE) Overlap Syndrome with subsequent chronic polyarthritis presented to the emergency room after routine labs showed severe anemia (Initial Labs: Table 1). The patient had previous episodes of autoimmune-hemolytic anemia resulting in hemoglobin levels of 4.0 mg/dl or lower. Therapy at the time of evaluation included prednisone 5 mg every other day at home, methotrexate 200 mg/week, and folic acid 1 mg daily to treat RA/SLE overlap syndrome. She reported increasing fatigue over the past few days without joint pain, cough, fever, chills, or any other constitutional symptoms; however, she noted recent weight loss.
Notably, the patient had a positive interferon gamma release assay ([IGRA], QuantiFERON Gold) screening two years prior (Table 2) that had not been addressed. The patient immigrated from Honduras, a tuberculosis (TB)-endemic region, three years prior. She did not recall having received vaccination against TB nor ever receiving therapy for latent TB infection. She had no previous incarcerations, or hospitalizations related to tuberculosis.